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Implications for Management

Elias J. Arous, MD; Patricia L. Baum, BSN; Bruce S. Cutler, MD

Arch Surg. 1984;119(7):780-783.

Abstract
• We observed myocardial ischemia in 135 of 808 patients undergoing routine ECG-monitored treadmill tests before vascular reconstructive operations. Postoperative infarction incidence was 27% among 56 patients who had operations regardless of test results. When patients had a lesser procedure, such as extra-anatomic bypass, infarction incidence decreased to 17% (not statistically significant). Ten patients having staged aortocoronary and peripheral reconstruction had no myocardial infarctions postoperatively or during follow-up of up to five years. Of 37 patients asymptomatic for coronary artery disease who had normal ECGs at rest, 24% of those undergoing a standard intra-abdominal operation suffered myocardial infarctions. At present, such asymptomatic but high-risk patients can be identified only by routine ECG stress testing or coronary angiography. Patients with an ischemic response to exercise have the best chance for long-term survival through staged coronary and vascular reconstruction.

(Arch Surg 1984;119:780-783)

Author Affiliations
From the Department of Surgery, University of Massachusetts Medical School, Worcester.

Footnotes
Accepted for publication Feb 15, 1984.

Read before the tenth annual meeting of the New England Society for Vascular Surgery, Bretton Woods, NH, Sept 29, 1983.

Reprint requests to Department of Surgery, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01605 (Dr Cutler).

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